Port-access minimally invasive cardiac surgery in a patient without arms

Abstract

INIMALLY INVASIVE cardiac surgery has gained prominence over the past several years and can be divided into two groups: beating-heart cardiac surgery without cardiopulmonary bypass (CPB) I and Port-Access (Heartport, Inc, Redwood City, CA) cardiac surgery with CPB. 2 Port-Access cardiac surgery uses a system of catheters and cannulae placed in the internal jugular vein and femoral artery to provide closed-chest CPB and enables the heart to be arrested and protected with cardioplegic solution in a manner equivalent to that used in conventional open cardiac surgery. Catheter and cannula placement are facilitated by transesophageal echocardiography and fluoroscopy. Application of the technique introduces unique monitoring considerations to the anesthesiologist. 2 During CPB, verification of proper positioning of the endoaortic balloon is vital because distal migration may compromise cerebral blood flow by occluding the brachiocephalic artery. Bilateral radial artery catheters are routinely used in most institutions to ensure proper positioning of the endoaortic balloon in the ascending aorta throughout CPB. 2 The authors report the successful management of a patient undergoing Port-Access cardiac surgery in whom radial artery pressures could not be monitored.